On March 5 the CDC released two very important articles regarding the control of Staph Infections. The news was not good, rates are no longer falling. Total deaths from Staph aureus bloodstream infections in 2017 were almost 20,000. But there was a ray of hope. The Veterans Health Administration reported a huge decrease in the deadly Staph infection, MRSA, with the promotion of facility-wide hand hygiene, and the testing of all admitted patients for MRSA. However, they only observed a mild decrease in non-MRSA Staph infections. A testament to the importance of carrier identification.
I wish I could say this idea originated in the United States. But identification of those harboring dangerous pathogens is a very old strategy and these results are not new, but confirmatory of the same results observed in the United Kingdom’s National Health Service, which heavily relies on surveillance to decrease MRSA infections.
Kentucky has not done as well. New data ranks our state in 40th place. Although we are doing better than how we are addressing Kentucky’s current Hepatitis A epidemic, which is now the worst in the nation, it is nothing to brag about. The University of Kentucky has the fourth highest number of MRSA bloodstream infections in the nation and ranks in the top 10 percent as adjusted for number of patient hospital days.
In addition, infection rates are also “risk adjusted”, which makes them appear better than they really are. Large hospital wards, being a teaching institution and having a high rate of MRSA in the community, all will mathematically lower the rates of infection, and in the University of Kentucky’s case, we estimate that this cuts its Standardized Infection Ratio or “SIR” in half. The industry’s call for more risk adjustment based upon community MRSA, is just a smokescreen to cover up poor performance.
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Compounding the ambiguity is that the vast majority of hospitals are denoted by the Federal Government as “no different from the national benchmark”, making their suboptimal performance appear good, when we are actually nowhere near on track to meeting the 2015 Federal Government’s goal of cutting the MRSA bloodstream infections in half by 2020.
A common excuse given for our MRSA epidemic is the high rates of all Staph Infections found in the opioid dependent patients. However, hard numbers are not available, since we do not even have a reliable number for all MRSA infections in the general population. But if a person has a chance of carrying MRSA, shouldn’t we then test for this upon admission, rather than letting the patient lie around, eventually developing an infection and infecting others.
Screening all individuals admitted to a hospital is of utmost importance. The CDC estimates that 2 percent of the population harbor MRSA. A recent article by Huang, et al., was published in the NEJM in February of this year, found that identification and decolonization of MRSA carriers after they leave a hospital markedly decreases the chances that they will develop an infection. Thus, identifying carriers is important, not only for the prevention of spread, but also for improving the healthcare of the individual carrying the dangerous pathogen.
Instead of mathematically massaging the numbers lets institute additional interventions which other institutions have used successfully. Hand-washing is extremely important, but in the context of multi-resistant drug organisms it is a backup measure, since these dangerous bacteria should not be on a healthcare workers’ hands in the first place.
The healthcare industry needs to accept responsibility for our present epidemic of MRSA in the community and become a leader in the solution to clean up this dangerous pathogen rather than a generator of excuses and political deflection. I feel the argument that MRSA in the community is from the farm and not hospitals is nothing more than diversion of responsibility. A recent research prepublication out of the European Union found the main driver of the epidemic of resistant bacteria in humans is the healthcare industry and not antibiotic usage in livestock.
Currently, in Kentucky, I have heard some organizations are not following CDC recommendations of isolation of all known carriers and patients infected with MRSA or following World Health Organization recommendations to test preoperative patients for Staph aureus. We are not even testing preoperative patients for the deadly form of Staph, MRSA. In addition, Kentucky hospitals need to screen all patients admitted to a facility for MRSA. Healthcare workers also need to be included and an economic safety net developed for those who have acquired dangerous pathogens.
As aptly stated by the CDC “Successful MRSA prevention requires action both at the healthcare facility level, among healthcare providers and healthcare leadership.
Kevin T. Kavanagh is a retired physician and board chairman of Health Watch USA.